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Health Reform Ideas in the Primeval Soup
Unformatted Document Text:  10 Stanford Professor Alain Enthoven. It was loosely modeled on the approach to providing health insurance to federal employees (FEHBP). Under the Clinton Plan every American would be part of a regional purchasing group pool, called health alliances. Employers (with employee premium contribution) would pay a premium to the purchasing group on behalf of their employees. The federal government would pay for those not working. Thus, everyone would have access to health insurance. The purchasing pool would negotiate with insurance companies a standard price for coverage with defined comprehensive benefit packages. Typically a consumer would have a choice between policies organized around fee-for-service, PPO, or HMO approaches with differential premiums for each. All employers were to pay premium costs for employees, including partial payment for part-time workers. A premium cap with regulated maximum yearly increases was proposed as a backup to the expected market incentives to limit cost increases. 19 President Clinton’s initial speech announcing the program was generally well received, but within a few months it was obvious the plan was mired in the Congressional process. In both the House and the Senate jurisdictional rivalries led the bill to be assigned to multiple committees. Most Republicans quickly decided to oppose the whole idea of universal coverage rather than work to amend the bill. 20 Democrats were in at least three camps: those favoring a traditional national health insurance approach with a public program, those favoring incremental changes in the insurance market to increase coverage without mandates or large new public expenditures thus accepting something less than universal coverage, those, even with some reservations, supporting the Clinton plan and perhaps seeking to amend it. The process did produce bills from the Ways and Means Committee in the House as well as the Education and Labor, and Finance Committee in the Senate. But, each bill was different and departed significantly from the original Clinton proposal. At the end of the Summer of 1994 it was evident no bill had the votes to pass in either chamber. With the 1994 election looming the effort was abandoned for the 103 rd Congress. 21 In the November elections the Republicans won a decisive victory and regained control of both the House and Senate. The window of opportunity had slammed shut, and would remain closed for at least the next twelve years during the remainder of the Clinton term and the presidency of George Bush. 19 Walter Zelman, The Rationale Behind the Clinton Health Reform Plan, Health Affairs, Spring 1994, pp 9-29.; Hacker, The Road to Nowhere, Chap 5. 20 Johnson-Broder, op.cit, 21 Johnson-Broder, op.cit

Authors: Brasfield, James.
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10
Stanford Professor Alain Enthoven. It was loosely modeled on the approach to providing
health insurance to federal employees (FEHBP).
Under the Clinton Plan every American would be part of a regional purchasing group
pool, called health alliances. Employers (with employee premium contribution) would
pay a premium to the purchasing group on behalf of their employees. The federal
government would pay for those not working. Thus, everyone would have access to
health insurance. The purchasing pool would negotiate with insurance companies a
standard price for coverage with defined comprehensive benefit packages. Typically a
consumer would have a choice between policies organized around fee-for-service, PPO,
or HMO approaches with differential premiums for each.
All employers were to pay premium costs for employees, including partial payment for
part-time workers. A premium cap with regulated maximum yearly increases was
proposed as a backup to the expected market incentives to limit cost increases.
19
President Clinton’s initial speech announcing the program was generally well received,
but within a few months it was obvious the plan was mired in the Congressional process.
In both the House and the Senate jurisdictional rivalries led the bill to be assigned to
multiple committees. Most Republicans quickly decided to oppose the whole idea of
universal coverage rather than work to amend the bill.
20
Democrats were in at least three
camps:
those favoring a traditional national health insurance approach with a public
program,
those favoring incremental changes in the insurance market to increase
coverage without mandates or large new public expenditures thus accepting
something less than universal coverage,
those, even with some reservations, supporting the Clinton plan and perhaps
seeking to amend it.
The process did produce bills from the Ways and Means Committee in the House as well
as the Education and Labor, and Finance Committee in the Senate. But, each bill was
different and departed significantly from the original Clinton proposal.
At the end of the Summer of 1994 it was evident no bill had the votes to pass in either
chamber. With the 1994 election looming the effort was abandoned for the 103
rd
Congress.
21
In the November elections the Republicans won a decisive victory and
regained control of both the House and Senate. The window of opportunity had slammed
shut, and would remain closed for at least the next twelve years during the remainder of
the Clinton term and the presidency of George Bush.
19
Walter Zelman, The Rationale Behind the Clinton Health Reform Plan, Health Affairs, Spring 1994, pp
9-29.; Hacker, The Road to Nowhere, Chap 5.
20
Johnson-Broder, op.cit,
21
Johnson-Broder, op.cit


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